Provider Demographics
NPI:1760446090
Name:CANTOR, DAVID S (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:CANTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 STATE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8225
Mailing Address - Country:US
Mailing Address - Phone:770-813-0404
Mailing Address - Fax:
Practice Address - Street 1:6015 STATE BRIDGE RD
Practice Address - Street 2:#12206
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6454
Practice Address - Country:US
Practice Address - Phone:770-813-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA#1464103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist